Epidural injections can be performed from several different approaches; these include a caudal, interlaminar, or transforaminal approach. The approach your provider chooses is based on each individual patient’s clinical presentation, the personal preference and experience of the provider performing the injection, the desired outcome, and most importantly, the risks versus benefits of performing one type of epidural over another. Clinically, the purpose of all epidural injections is to place a mixture of steroid and local anesthetic at the source of the problem to decrease inflammation causing pain, and to promote healing and clinical improvement. The epidural steroid injection involves placing steroid medication in the inflamed area and significantly reduces nerve irritation thus improving pain. This treatment option has the potential to completely resolve pain and ultimately may prevent operative treatment.
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back ( lumbar radiculopathy ), such as from lumbar spinal stenosis , cervical spinal stenosis, herniated disc , and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy , which causes pain.
For many people, back pain goes away on its own or with nonsurgical treatments. Epidural steroid injections shouldn't typically be used as a first-line therapy for back pain relief, but that doesn't mean they can't play a role in treating pain. But injections won't cure the underlying cause of back pain, and they provide only temporary relief. Unfortunately, in many cases, chronic back pain can't be cured, but must instead be managed, like other chronic conditionsand patients must have realistic expectations of what epidurals can do.